Online support forums have been recognised as an area of increasing popularity and support for individuals experiencing a range of health conditions and experiences. This is the first research paper to examine the discussions that take place within miscarriage support forums to gain an understanding of the experiences associated with miscarriage and the use of online miscarriage peer support.

Arguments have been forwarded that terminating a pregnancy affected by a congenital abnormality discriminates against those living with disabilities and makes negative judgements about their lives. For the clinical geneticist these arguments raise questions as to whether their practice is ethical. In this thesis I aim to consider these concerns primarily from the position of the clinical geneticist by addressing ethical arguments. I argue that the fetus does not have full moral status equivalent to a person and therefore terminating a disabled fetus is not comparable with ending the life of a disabled person, and so does not imply that the lives of disabled persons are not worth living. I further argue that the decision to carry out prenatal testing and abortion should not solely rely on disability and on the objective opinions of healthcare professionals. Central to this argument is that when considering whether or not prenatal testing and abortion are justifiable, it is important to take into account the specific and unique circumstances of the family, particularly the parents and pre-existing children. Parents’ reproductive autonomy therefore needs to be considered as well as the harm having a disabled child could cause; both to the future child to and those directly affected by their existence. I conclude that prenatal testing and abortion does not discriminate against those living with disabilities. Despite this, however, reproductive autonomy is not being respected in current approaches to prenatal testing as late termination of pregnancy can only be legally permitted where two healthcare professionals agree to it. Therefore, in order to enhance reproductive autonomy I have made recommendations whereby the supportive role of the clinical geneticist can be further developed by their acting as an advocate for prospective parents when justifications for late termination of pregnancy are being considered by healthcare professionals.

Background: In Pakistan, the prevalence of perinatal depression is high and is associated with adverse outcomes in both the mothers and their infant. Although effective psychosocial interventions have been developed for such settings, the scarcity of trained mental health professionals means that the majority of such women do not receive any intervention. The aim of this study was to explore the acceptability of peer volunteers (PVs) - volunteer lay women from the community with shared socio-demographic and life experiences with the target population – as delivery agents of a psychosocial intervention for perinatal depression in a rural area of Pakistan. Methods: This qualitative study was embedded in the pilot phase of a cluster randomised control trial. Participants included the entire sample of the pilot study: mothers (n=21), PVs (n=8), primary health care staff (n=5), husbands (n=5) and mothers-in-law (n=10). Data were collected, from these key stakeholders, through in-depth interviews and focus group discussions. Data analysis was underpinned by Framework Analysis involving five key stages: familiarisation, development of thematic framework, indexing, charting and interpretation. Results: All stakeholders viewed the PVs as acceptable delivery agents of a psychosocial intervention for perinatal depression. The PV’s personal attributes such as being local, empathic, trustworthy, approachable and of good reputation within their communities contributed to their acceptability. Their linkage with the primary health care system was vital to their legitimacy and credibility. Factors such as appropriateness of the intervention, effective training and supervision, perception of personal gain from the programme, and endorsement from their families and the community were motivational for them. Likely barriers to their work were women’s lack of autonomy, cultural beliefs around the perinatal period, stigma of depression, lack of some mothers’ engagement and resistance from some families. Conclusion: PVs are a potential human resource for the delivery of a psychosocial intervention for perinatal depression in this rural area of Pakistan. The use of such delivery agents could be considered for other under-resourced settings globally, and for other mental health conditions.